Symptom Trajectories Informing Patient Care After Lung Cancer Surgery: A Longitudinal Patient-Reported Outcome Study

作者全名："Tang, Li; Yu, Hongfan; Dai, Wei; Yang, Xiaojun; Wei, Xing; Wang, Xin Shelley; Cleeland, Charles S. S.; Li, Qiang; Shi, Qiuling"

作者地址："[Tang, Li; Shi, Qiuling] Chongqing Med Univ, Coll Biomed Engn, Sch Publ Hlth & Management, State Key Lab Ultrasound Med & Engn, Chongqing 400016, Peoples R China; [Yu, Hongfan; Shi, Qiuling] Chongqing Med Univ, Sch Publ Hlth, Chongqing, Peoples R China; [Dai, Wei; Yang, Xiaojun; Wei, Xing; Li, Qiang] Univ Elect Sci & Technol China, Sichuan Canc Hosp & Inst, Dept Thorac Surg, Sichuan Canc Ctr, Chengdu, Sichuan, Peoples R China; [Wang, Xin Shelley; Cleeland, Charles S. S.] Univ Texas MD Anderson Canc Ctr, Dept Symptom Res, Houston, TX USA"

通信作者："Shi, QL (通讯作者)，Chongqing Med Univ, Coll Biomed Engn, Sch Publ Hlth & Management, State Key Lab Ultrasound Med & Engn, Chongqing 400016, Peoples R China.; Shi, QL (通讯作者)，Chongqing Med Univ, Sch Publ Hlth, Chongqing, Peoples R China."

来源：ANNALS OF SURGICAL ONCOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000918186400002

JCR分区：Q1

影响因子：3.4

年份：2023

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期号：　

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文献类型：Article; Early Access

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摘要："BackgroundApplication of patient-reported outcomes (PROs) in surgical oncology has been limited because of patient heterogeneity. We analyzed symptom trajectories and their associations with recovery outcomes after lung cancer surgery, aiming to profile the heterogeneity of patients' experiences and to identify patients needing extensive care.MethodsSymptoms were assessed with the MDASI-LC before surgery, daily after surgery in hospital and weekly within 1 month after discharge. Patients were clustered based on symptoms from post-operative day 1 (POD1) to POD5, using the latent-class-trajectory-model. Functional recovery was compared across the trajectories. Logistic regression was used to explore risk factors for trajectories of more severe symptoms.ResultsBased on the five most severe post-surgery symptoms (pain, fatigue, coughing, shortness of breath, and disturbed sleep), we identified three distinct symptom trajectories among 424 patients [mild, N = 225 (53.07%); severe-to-mild, N = 86 (20.28%); severe, N = 104 (24.53%)]. At discharge, more 'severe' patients (73.96%) did not achieve a functional recovery compared with those in mild (32.54%, P < 0.0001) or severe-to-mild (56.96%, P = 0.0274) groups. Factors of significant symptom increase on POD1 were younger-than-55 (OR = 1.94 [95% CI 1.30-2.93], P = 0.001), undergoing open or multi-port video-assisted thoracoscopic surgery (OR = 1.59 [95% CI 1.05-2.41], P = 0.03), and using two chest tubes (OR = 1.72 [95% CI 1.12-2.65], P = 0.01). For patients experiencing dramatic symptom increase on POD1, older age (OR = 2.51 [95% CI 1.40-4.59], P = 0.002) was associated with 'severe' trajectory.ConclusionsThis study demonstrated that PRO measures were capable of profiling heterogeneous symptom trajectories after lung cancer surgery. Those in-hospital trajectories were able to differentiate patients' responses to treatments and signal the needs for extensive post-discharge care."

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